Danger : adultes !

RésuméLes vrais enfants sont souvent les parents, disait Lacan. La psychanalyse permet de repérer et de prévenir le danger que les parents représentent, souvent à leur insu, pour leurs enfants : ils transmettent les souffrances et les incompréhensions qu’ils ont eux-mêmes subies sans pouvoir les dépasser. Ainsi le danger pour l’enfant ne se limite pas aux conséquences des actes incriminés par la loi pénale : séduction, abus, violence. Il y a aussi l’impardonnable ignorance, les cachotteries en tout genre, le désir fusionnel, l’indifférence, l’exploitation de l’enfant comme locomotive de la consommation, etc.. The true children are often the parents, Lacan would say. Psychoanalysis allows us to identify and prevent the danger which parents, often unwittingly, represent for their children : they transmit their own sufferances and misunderstandings which they have not been able to surpass or solve. Thus the risk run by children cannot be limited to the consequences of crimes condemned by the law : violence, sexual abuse. There are also the unforgivable ignorance, all kinds of secrets, indifference, desire of fusion, exploitation of the child as potential consummer.

KALTENBECK, Franz

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La politique migratoire française et les immigrés âgés

Pendant longtemps, la politique française d'immigration s'est attachée au recrutement, à la réglementation du séjour et à la gestion sociale des travailleurs étrangers. La stabilisation de l'immigration familiale a introduit, à partir de 1974, une nouvelle donne dans le mode de traitement de l'immigration par la politique publique, tandis que les «secondes générations» ont progressivement déplacé le débat sur l'intégration des jeunes. Une classe d'âge a été oubliée : celle des personnes âgées, initialement considérées comme ayant vocation au retour et progressivement délégitimées une fois qu'elles avaient quitté le marché du travail. Un bilan de la manière dont la politique migratoire française a envisagé la question du vieillissement des immigrés et un inventaire des données de la recherche dont on dispose aujourd'hui sur ce thème.. Wihtol de Wenden Catherine. La politique migratoire française et les immigrés âgés. In: Hommes et Migrations, n°1140, février 1991. Voyage au bout de la vie. pp. 6-8.

Wihtol de Wenden, Catherine

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Analyse d'entretiens. Refondation de l'explication des votes FN

Le Bohec Jacques. Analyse d'entretiens. Refondation de l'explication des votes FN. In: Mots, n°58, mars 1999. Argumentations d'extrême-droite, sous la direction de Simone Bonnafous et Pierre Fiala. pp. 129-151.

Le Bohec, Jacques

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Remarques éthiques et philosophiques sur le post-humanisme

À partir de quelques philosophes du post-humanisme, cet article focalise sur les difficultés proprement anthropo-éthiques d’instauration d’une société post-humaniste à partir de la critique de la « mécanisation de l’humain » qui a marqué la démesure de l’homme dès le début des temps modernes. Le contexte de justification et de signification de cette nouvelle perspective biotechnologique, bio-catastrophique et scientifico-technique, si controversée, conduit à évaluer anthropo-philosophiquement l’émergence de « l’homme augmenté ». Celui qu’il convient d’appeler maintenant « le post-humain ». Ce post-humain est celui du contemporain décrit et analysé au cœur de la philosophie et de l’anthropologie de la technoscience. L’enjeu anthropo-philosophique de la démarche évaluative critique sur les « carences éthiques » consiste donc à se demander si la futurologie envisagée sans humanité et sans « humanitude » ne détruit pas les sociabilités anciennes et nouvelles. De cette question directrice procède la mise au jour des imperfections et des carences des systèmes techno-logiques qui déshumanisent la société. . Considering some philosophers of post-humanism, this article focalizes the attention on the anthropo-ethics difficulties about the instauration of a post-humanist society from the critic of the “mechanization of the humain” that has marked the amplification of the humankind from the beginning of modern times. The context of justification and signification of this new biotechnological perspective, bio-catastrophic and scientific-technique, conduct us to evaluate the emergence of the “augmented man” that is possible to call post human. This is a contemporary figure described and analyzed by philosophy and anthropology of technoscience. The anthropo-philosophical issue of the evaluated critic on the “ethic deficiencies” consist to ask us if the futurology planned without humanity and “humanitude” don’t demolish the old and new sociabilities. From this question proceed the updating of the imperfections and deficiencies of the techno-logic systems that dehumanise the society.

Nsonsissa, Auguste

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Sciences humaines et médecine

Collection

Test alfeo

Haute Autorité de Santé, HAS

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Planning ahead : protocol for a randomised trial of advance care planning for community dwelling older adults at increased mortality risk

INTRODUCTION: An important goal of advance care planning (ACP) is ensuring that patients receive care concordant with their preferences. High-quality evidence is needed about the effect of ACP on this and other outcomes. METHODS AND ANALYSIS: Planning Ahead is a randomised controlled trial to test the effectiveness of facilitated ACP in community-dwelling older adults including those with normal cognition and those with Alzheimer's Disease and Related Dementias (ADRD) who are at high risk of death. The primary aim is to determine the effect of the intervention on discordance between preferences for medical treatments and the treatments received in the year after the intervention. Secondary outcomes include decision-making quality, care at the end of life and cost. Eligible patients have a primary care provider at one of two Midwest health systems, have an approximate 33% mortality risk and do not have a POLST form at baseline. Patients with capacity can invite the person they would choose to be their healthcare decision maker to participate as a study partner. A surrogate decision maker enrols and receives the intervention for patients who lack capacity due to ADRD. The intervention uses the Respecting Choices Advanced Steps (RCAS) model of ACP delivered by a registered nurse and includes identification of the patient's values and goals, education about ACP and the POLST form and the opportunity to complete a POLST form. ETHICS AND DISSEMINATION: The study is approved by the Indiana University Institutional Review Board. Primary and secondary analyses will be published in peer-reviewed journals. We also plan dissemination through the media. We will construct a deidentified data set that could be available to other researchers. Survey data will be preserved and shared via the NIH-supported National Archive of Computerised Data on Ageing's (NACDA) Open Ageing Repository (OAR). TRIAL REGISTRATION NUMBER: NCT04070183.

TORKE, Alexia M.

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Advancing symptom alleviation with palliative treatment (ADAPT) : a qualitative study to understand how a nurse and social worker palliative telecare team improved quality of life in chronic illness

The Advancing Symptom Alleviation with Palliative Treatment (ADAPT) trial found that a nurse and social worker palliative telecare team (providing care via phone) improved quality of life in older Veteran patients with chronic illness. Our objective was to describe clinician and patient experiences of ADAPT and how ADAPT influenced Veterans' quality of life. We used thematic analysis on structured interviews with 36 randomly selected patients, semi-structured focus groups with nine palliative care intervention team clinicians, and clinical intervention summaries of 147 patients. ADAPT proved to be an effective model for most Veterans by improving Veterans' health care delivery and navigation and promoting timely and holistic health care and teaching skills that improved wellbeing. ADAPT also helped to improve patient engagement and sense of agency. These findings provide insights into how ADAPT improved Veterans' quality of life through a nurse and social worker telecare team.Randomized Control Trial Registry Number: CinicalTrials.gov NCT02713347.URL For Trial Registry: https://clinicaltrials.gov/study/NCT02713347.

LADEBUE, Amy

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Legacy-making interventions in pediatric palliative care : a mixed methods systematic review

OBJECTIVE: To identify existing legacy-making interventions for children in the context of palliative care, to evaluate the reported outcomes of these interventions, and to explore the perceptions and experiences of children, family members, and healthcare professionals regarding these interventions. METHODS: A mixed-methods systematic review was conducted. Six English databases, including PubMed, the Cochrane Library, Embase, CINAHL via EBSCO, ProQuest Nursing & Allied Health Database, and PsycINFO via EBSCO, and three Chinese databases, including CNKI, Wanfang, and Weipu, were systematically searched from inception to July 21, 2024. Articles reporting the results of qualitative, quantitative, or mixed-methods studies related to legacy-making interventions for children receiving palliative care were selected. A meta-synthesis and a quantitative narrative synthesis were conducted, and the findings were integrated using a convergent segregated approach. RESULTS: Twenty-one articles were included. Existing legacy-making interventions were categorized into tangible legacy items and living legacy projects. These interventions were found to have numerous benefits, such as improving children's quality of life, preserving dignity, fostering adaptive coping mechanisms for illness-specific stressors for both children and their parents, enhancing parent-child communication, and promoting psychosocial well-being. They also contributed to reducing compassion fatigue and burnout among healthcare professionals. The majority of children's and parents' experiences with legacy-making interventions were positive, with high acceptability of these interventions. Suggestions from family members and healthcare professionals for enhancing these interventions were also reported. CONCLUSIONS: Legacy-making interventions could benefit children, their families, and healthcare professionals. More rigorous clinical trials should be conducted to confirm the effects of these interventions in the future. SYSTEMATIC REVIEW REGISTRATION: This systematic review has been registered on PROSPERO (Registration No. CRD42024490925).

DENG, Chanjuan

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Nursing support for nonpharmacological interventions to prevent delirium in patients with cancer : a scoping review

Introduction: The importance of nonpharmacological interventions in preventing delirium is well documented in several guidelines; however, research specifically detailing nursing support in oncology remains sparse. This scoping review aimed to identify nursing support for nonpharmacological interventions to prevent delirium in patients with cancer. Methods: Utilizing Arksey and O’Malley’s six-stage scoping review framework and adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR checklist, we systematically searched PubMed, CINAHL, CENTRAL, and Ichushi-Web databases from their inception to January 31, 2022, with an update on August 31, 2023. Additional relevant studies were identified through manual searches of key journals and article lists. Studies that reported on patients with cancer aged =18 years, interventions for preventing delirium, nursing support, and quantitative data showing outcomes were included. Results: A total of 794 articles were screened, and 10 met the inclusion criteria. Among these, six were randomized controlled trials (RCTs) and four were non-RCTs. The thematic analysis categorized nursing support into four components: (1) multicomponent interventions, (2) bright light therapy, (3) specialist team approaches, and (4) family support. Most interventions were applied during surgical procedures and were effective in preventing postoperative delirium, especially multicomponent interventions and bright light therapy. Conclusion: This review highlights that nursing support for delirium prevention in patients with cancer encompasses multicomponent interventions, bright light therapy, specialist team approaches, and family support. Future research should examine the effectiveness of this nursing support using systematic reviews and meta-analyses and explore the feasibility of implementing it in nursing practice.

KANNO, Yusuke

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Performance status as an indicator for palliative care referral

Palliative care can lead to improved quality of life and often extends life, particularly when it begins early in the cancer care continuum. Even with these positive outcomes, many clinicians do not use palliative care early or frequently enough. This is potentially because of the providers’ difficulty in determining when in the disease trajectory to refer their patients. This article highlights potential triggers for palliative care referral using existing evaluation tools, and identifies gaps in research using these tools. The Karnofsky Performance Status Scale and Eastern Cooperative Oncology Group Performance Status Scale are potential tools that could assist in determining when to refer patients with cancer to palliative care.

PONDER, Tonya

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Managing moral distress and complex ethical challenges in the NICU

BACKGROUND: In neonatology, end-of-life and complex ethical issues are frequent. This may lead to experiences of moral distress (MoD) for members of the clinical team. Here, we identify the causes, contributing factors, and contexts of MoD in the neonatal intensive care unit (NICU) and review interventions designed to manage complex ethical issues and alleviate MoD. We give a practical example of how support clinicians can help manage MoD. METHODS: Systematic reviews identify the causes, contributing factors, and contexts of MoD in NICUs as well as interventions to alleviate MoD. We trained an interdisciplinary team of support clinicians to be mentors in the NICU, to support other clinicians in managing the MoD associated with challenging cases. RESULTS: Managing MoD in NICUs is complex. Support clinicians actively assisted over 400 other clinicians. All were satisfied with the training and used their skills, mainly to optimize communication between clinicians and parents and/or for palliative care cases; 60% of all cases support clinicians managed were directly related to MoD; the majority resolved with initial reflective steps. CONCLUSION: An interdisciplinary and multifaceted approach to addressing MoD in the NICU can be operationalized through support clinicians providing interdisciplinary and multifaceted interventions.

BOUTILLIER, Béatrice

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Evaluation of the implementation of a multi-component advance care planning programme in nursing homes

Advance care planning (ACP) increases the likelihood that nursing home (NH) residents will receive end-of-life care that is consistent with their preferences. However, their preferences are often unknown. This paper aims to identify the key enablers and constraints that influenced the implementation of a new multicomponent ACP programme. A qualitative study guided by the Normalisation Process Theory was conducted. Six ACP leaders and eighteen implementers participated in interviews and focus group discussions respectively. Data were analysed using reflexive thematic analysis and revealed five themes: (1) making sense of ACP in a NH context, (2) upskilling with new processes, (3) lack of collective action to adapt and integrate ACP, (4) appraisal of structural and process challenges, and (5) experience of cognitive dissonance. While the programme supported the building of individual and collective competency for ACP facilitation, prevailing sectoral and organisational context challenged NHs' ability to integrate ACP and to reap its expected benefits.

TAN, Woan Shin

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Navigating challenges in palliative care : a survey on ASCO guideline adherence among health care providers in low- and middle-income countries

PURPOSE: Integrating palliative care into oncology is essential, yet disparities in access and quality persist, particularly in low- and middle-income countries (LMICs). The ASCO guidelines advocate for early, routine, interdisciplinary palliative care for patients with advanced cancer. Barriers to implementing these recommendations include resource limitations, inadequate training, and cultural perceptions. Recognizing these challenges is essential for improving equitable access to palliative care worldwide. METHODS: This prospective survey assessed adherence to ASCO recommendations for palliative care integration among LMIC health care providers (HCPs). Participants were recruited via e-mail, social media, and a list of members involved in the ASCO Palliative Care Communities of Practice from February to May 2024. The survey included sections on sociodemographic information, self-perceived adherence to ASCO guidelines on a 5-point Likert scale, and open-ended questions on implementation barriers. Data were collected using Research Electronic Data Capture system. Participants were grouped by WHO regions. Descriptive statistics were used to summarize characteristics and adherence scores, and chi-square tests were used to evaluate regional differences. Thematic analysis identified key themes from open-ended responses. RESULTS: One hundred eighty HCPs participated; 62% was female, and 51.1% was age 35-44 years. Most were physicians (66%), and 50% lacked palliative care specialization. Adherence to ASCO guidelines varied, with early palliative care referrals ranging from 50% in the Americas region to 0% in the Western Pacific region. Key barriers included lack of policy support (25%), unmet educational needs (22%), and accessibility constraints (19%). CONCLUSION: Addressing identified barriers through evidence-based advocacy, comprehensive policy changes, training, and continuing education programs is essential for integrating palliative care into oncology services across LMICs, promoting health equity for patients with cancer.

BERGEROT, Cristiane Decat

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Physician-assisted dying witnessed by emergency medical services : a case report

INTRODUCTION: Physician-assisted dying (PAD) is a practice that allows terminally ill patients to self-administer prescribed lethal medication. In the 11 states in the United States where PAD is legal, the incidence of PAD cases is rapidly rising. Despite most of these cases occurring in the out-of-hospital setting, states lack specific emergency medical services (EMS) protocols to guide prehospital responders who may encounter PAD in the field. We report a case in which a patient called 9-1-1 for a medical emergency and requested to ingest her prescribed lethal medication while in EMS care. CASE PRESENTATION: Emergency medical services was dispatched for a 56-year-old female bleeding from her tracheostomy stoma. Despite the EMS responders' recommendation, the patient refused transport and instead requested to ingest her PAD medication. The crew, unfamiliar with PAD laws, were unsure whether they could legally honor the patient's refusal. Clinicians consulted with online medical control, who were also unaware of PAD. After extensive deliberation, the crew decided to honor the patient's refusal and thoroughly document the situation. The patient self-administered her medication as EMS cleared the scene. CONCLUSION: This case highlights logistical challenges and ethical dilemmas faced by EMS responders and underscores the complexity of balancing patient autonomy with legal and medical responsibilities in prehospital situations involving PAD. As PAD becomes increasingly prevalent, equipping EMS responders with clear protocols and providing ongoing education about prehospital PAD cases are vital for preserving patient rights while protecting the responders from legal and ethical uncertainty.

POTLURI, Saahith

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Meta-aggregation of facilitators and barriers to home-based palliative care

BACKGROUND: Home-based palliative care is in the early stages of development, and its implementation continues to face numerous challenges. OBJECTIVE: This study aims to systematically synthesize qualitative research on the facilitators and barriers to home-based palliative care, offering evidence-based recommendations to support the advancement of palliative care in China. METHODS: A systematic search was conducted across multiple databases including PubMed, Web of Science, Embase, Cochrane Library, CINAHL, CNKI, Wanfang,2222 and VIP Database for qualitative studies related to home-based palliative care, with the search covering studies published up to October 3, 2024. Quality assessment was performed using the JBI standards for qualitative research. Meta-Aggregation was performed using an aggregative integration approach, and the data were analyzed and managed using Nvivo software. CONCLUSIONS: Twelve studies involving 334 participants were included. Ninety-nine initial findings were extracted and categorized into eight groups. Facilitators included family support, collaboration within interdisciplinary teams, and community resource availability. Barriers comprised challenges in healthcare policies, cultural and social influences, lack of Knowledge and Attitudes of Healthcare Workers, lack of Knowledge and Attitudes of Patients and Families, and insufficient home care resources. CONCLUSION: To advance palliative care in China, it is critical to enhance policy support and financial backing, improve the education and training of healthcare professionals and the public in diverse cultural settings, strengthen community nursing capabilities, and explore the integration of information technology in care delivery.

LIU, Zixuan

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Palliative care burden and specialist service utilisation for individuals with cardiovascular disease in Australia : a national population-based observational study

BACKGROUND: Cardiovascular disease (CVD) is a major cause of death globally. In advanced stages, patients with CVD often require palliative care due to reduced health-related quality of life from physical, psychological and spiritual symptoms, along with physical disability. OBJECTIVES: To investigate (1) the symptom and function burden of patients with CVD on their first admission to specialist palliative care services and (2) how these care burdens, and other clinical characteristics, affected patients' utilisation of community-based versus inpatient services. DESIGN: A national population-based observational study using point-of-care outcomes sourced from the Australian palliative care outcomes and collaboration (PCOC). SETTINGS: Community-based and inpatient Specialist palliative care services across Australia registered in the PCOC. PARTICIPANTS: Patients who required specialist palliative care principally for CVD, and whose death occurred between 1 January 2013 and 31 December 2022. METHODS: Five validated clinical instruments were used to collect point-of-care outcomes on each individual's function (Resource Utilisation Groups - Activities of Daily Living (RUG) & Australia-modified Karnofsky Performance Status (AKPS)), symptom distress (Symptoms Assessment Scale & Palliative Care Problem Severity Score) and other clinical characteristics (Palliative Care Phases). Multivariable logistic regression was applied to evaluate how patients' functional and symptom burden influenced their use of inpatient versus community-based palliative care services. RESULTS: Our analysis included 17 002 patients with CVD, with 7539 (44.3%) receiving community palliative care services and 9463 (55.7%) accessing inpatient palliative care services. On admission to palliative care services, patients often exhibit significant physical functional impairments and substantial symptom burdens, particularly related to fatigue and breathing difficulties. In comparison, patients accessing inpatient services tended to have greater functional impairment (p<0.001) but commonly reported lower symptom burdens (p<0.001). Our analysis indicated that greater functional impairment (ORs ranged from 2.53 to 6.02, p<0.001 for RUG; ORs ranged from 1.72 to 5.02, p<0.008 for AKPS), poorer overall health condition (OR ranged from 1.28 to 17.60, p<0.001) and referrals by a community service (OR=0.16, 95% CI: 0.14 to 0.18, p<0.001) were a negative predictor of inpatient services use. Surprisingly, higher levels of symptom distress and challenges in symptom management were associated with a decreased likelihood of using inpatient services compared with community-based services. CONCLUSION: Patients with CVD frequently require support to manage decreased functional abilities, as well as symptoms like fatigue and breathing difficulties. With greater investment in community-based supportive services and a skilled palliative care workforce, more individuals with advanced CVD could potentially receive palliative care in community settings.

LI, Meng

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Compassionate communities : conceptual evolution and implications for nursing practice

Background and Purpose: Compassion is a well-known nursing principle with a rich literature on concept development and clarification. Despite being central to care and at risk of being compromised due to increasingly challenging working conditions, compassion continues to be described as a predominantly individual attribute, with the responsibility to demonstrate compassion (and address lack of compassion) placed squarely on the shoulders of individual nurses. There is scant literature holding health care institutions accountable for implementing policies and practices that demonstrate, support, and sustain compassion. Acknowledging the encouraging recent literature on the potential for compassionate leadership, we look to other models based on compassion as embedded in practices and communities to better examine how it can shape nursing work environments. Methods: This paper examines the Compassionate Communities movement, first developed at the intersection of public health and palliative care. We trace its development, highlight ongoing methodological and conceptual tensions, and showcase its applicability as a conceptual framework for research and policy in health care beyond the palliative care context, specifically in nursing. Results: Literature on Compassionate Communities aligns with the priorities and concerns of nursing care, policy, and research. It also has the potential to transform health care institutions, creating compassionate spaces for patients, families, and nurses themselves. Implications for Practice: Proposed definitions and principles for using Compassionate Communities as a conceptual framework are offered; considerations on how health care organizations can become more compassionate, using reflections from our program of research examining nurses' psychological safety.

SOFRONAS, Marianne

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Palliative semi-permanent abdominal drain for the management of refractory malignant ascites : a retrospective study in a comprehensive cancer center

PURPOSE: Refractory malignant ascites in the advanced palliative phase significantly impacts patients' quality of life (QoL), causing pain, respiratory difficulties, digestive issues, and impaired mobility. While iterative drainages can effectively relieve symptoms, frequent hospital visits and the significant volume of fluid requiring removal pose considerable challenges. A semi-continuous approach using a permanent bedside drain may offer more frequent drainages of smaller volumes. This study aimed to examine the feasibility, reliability, and safety of a semi-permanent bedside abdominal drain for patients in advanced palliative care with refractory malignant ascites. METHODS: This is a retrospective study, with cases identified through computerized queries of digital patient records. Data collected included patient characteristics, biological parameters, procedure details, and end-of-life outcomes. RESULTS: Between 2019 and 2024, this drain was proposed to 25 palliative care patients. They had received a median of three lines of oncological treatment, with 60% of them receiving exclusively palliative care at the time of drainage. Drain placement had a beneficial impact on disabling symptoms in over 92% of cases, allowing 60% of patients to return to home hospitalization, without requiring additional hospital visits for paracentesis. The median time between drain placement and end of life was 36.5 days [4;147], while the median time from the diagnosis of refractory ascites to death was 93.7 days [14;263]. CONCLUSION: A non-tunneled semi-permanent catheter, easily implanted at the patient's bedside, may improve QoL. This study serves as a pilot for a prospective cohort that will analyze QoL improvements and economic costs.

POISSON, Caroline

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External validation of the NECPAL CCOMS-ICO prognostic tool for early palliative care and mortality prediction in patients with advanced chronic conditions : a prospective observational study protocol

Early initiation of palliative care in patients with advanced chronic conditions significantly improves their quality of care; however, variability in disease trajectories complicates such interventions' timing. The NECPAL CCOMS-ICO prognostic tool was developed as a straightforward instrument to help healthcare providers in all clinical settings promptly identify patients with advanced chronic conditions who require palliative care, thereby enhancing service planning and delivery. Its latest version, 4.0, 2021, for the first time, incorporates a patient survival estimation. Nevertheless, validation is necessary. This study aims to validate the NECPAL version 4.0 tool in an independent cohort. It is an observational, prospective study involving outpatients and hospitalized non-randomized patients at Hospital Universitario Infanta Leonor-Virgen de la Torre in Madrid, Spain, all of whom have at least one advanced chronic condition. The study is scheduled to last 6 years, including a recruitment period of 30 months starting 1 February 2024, followed by a 12-month follow-up period for each patient. This is the first prospective study designed to validate the NECPAL version 4.0 instrument. Implementing this tool would allow the identification of patients with advanced chronic conditions and unmet palliative care needs and determine the more appropriate care pathway at the proper moment.

BUSTAMANTE-FERMOSEL, Ana

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Engagement and perspectives regarding the family conference process when considering discontinuation of life-sustaining treatments among critical care specialist nurses : a nationwide cross-sectional survey in Japan

BACKGROUND: Recognizing the importance of multidisciplinary collaboration during treatment family conferences is increasing in critical care settings. We aimed to elucidate how critical care specialist nurses engage in the family conference process in terms of the actual discussions held, the recommended topics, and their perspectives regarding transfer of critical care patients to general wards. METHODS: This self-administered nationwide survey was conducted between October and December 2020, targeting a random sample of 740 critical care specialist nurses. An anonymous questionnaire based on established guidelines and pilot tests was used to assess the level of engagement with the family conference process, content of discussions, considerations regarding withholding or withdrawing treatment, and perspectives concerning patient care location and discontinuation of life-sustaining treatments among the surveyed nurses. RESULTS: Of the 396 returned questionnaires (response rate, 51.9%), 384 were analyzed. Less than 35% of the nurses consistently participated in family conferences and ensured that decisions regarding withholding or withdrawing life-sustaining treatments were re-evaluated following the conferences. Discussions focused predominantly on the patients' physical aspects, whereas the nurses believed that patients' values and preferences should be discussed. More than 70% of the nurses supported transferring patients from critical care settings to general wards for end-of-life scenarios. CONCLUSIONS: Critical care specialist nurses in Japan exhibit limited engagement in family conferences and often fail to address their patients' values and preferences. Educational programs and enhanced interprofessional collaborations are warranted to improve nurse involvement in family conferences and ensure continuity of care between critical care and general ward settings.

KATO, Akane

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Process evaluation of a self-compassion-based online group psychotherapy programme for bereavement-related grief : a thematic analysis of the COMPACT feasibility trial

BACKGROUND: Bereavement-related grief and prolonged grief disorders are highly prevalent; however, standardised care approaches are lacking. To address this gap, the self-COMPAssion-based online group psyChoTherapy for bereavement-related grief (COMPACT) feasibility trial was developed; it showed promising participant engagement and potential effectiveness. This study aimed to elucidate the mechanisms underlying the impact, contextual factors, and implementation considerations of the COMPACT programme. METHODS: Online semi-structured interviews were conducted and analysed using a deductive reflexive thematic analysis guided by the UK Medical Research Council process evaluation framework. The interviews involved 21 participants and 10 intervention personnel from the COMPACT feasibility trial. The Helpful Aspects of Therapy Form (HATF) was used to guide the interviews, ensuring a focus on identifying mechanisms of impact, contextual factors, and implementation considerations. RESULTS: Four main "mechanism of impact" themes were identified: common humanity and self-awareness, perceived importance of self-care, deepening self-insights and personal growth, and amplified self-compassion. Two associated "contextual factor" themes (group therapy and a secure programme environment) were highlighted. Additionally, two "implementation consideration" themes (barriers and facilitators) were found, with related contextual themes of group therapy and online delivery. CONCLUSIONS: The core impact mechanisms of the COMPACT programme included accessible online delivery, group work enhancing common humanity, and a safe, supportive environment deepening self-insight, self-care, and self-compassion. Future research should prioritise refining programme content, improving participant assessment, and enhancing training for intervention personnel to enable a randomised controlled trial testing the effectiveness of the intervention. TRIAL REGISTRATION: UMIN000048554, registered 2nd August 2022.

TANI, Haruka

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Implementing voluntary assisted dying in New South Wales correctional settings

New South Wales was the last Australian state to pass voluntary assisted dying (VAD) legislation, effective on 28 November 2023.1 The Justice Health and Forensic Mental Health Network (JHNSW) is responsible for the health care of people in contact with the criminal justice system in NSW (www.nsw.gov.au/health/justicehealth/) and was tasked with implementing a VAD pathway for prisoners. A steering committee was formed with the Corrective Services NSW (CSNSW; https://correctiveservices.dcj.nsw.gov.au/), the local health district, the CSNSW Inmate Consumer Referent Group, the Mental Health Review Tribunal (https://mhrt.nsw.gov.au/the-tribunal/), the JHNSW Clinical Ethics Committee, the Victims Support Scheme and the Aboriginal Health and Medical Research Council of NSW (www.ahmrc.org.au) to create dignified and culturally safe pathways for prisoners to access VAD. The ethical and legal challenges of integrating VAD into the NSW correctional settings are highlighted below, with a hypothetical patient journey demonstrating the pathway.

AHLUWALIA, Diya

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Reasons to access the emergency department by patients who receive palliative home care : a scoping review

BACKGROUND: The progressive aging of society has increased the prevalence of chronic, incurable diseases, creating a critical need for palliative care programs. Palliative home care services are essential for patients facing severe symptoms and barriers to accessing health care facilities. Despite this, many patients receiving palliative home care services still access emergency departments (EDs). OBJECTIVES: This scoping review aimed to investigate ED visits among patients under palliative home care services, examining factors influencing access, patient characteristics, and leading reasons for ED visits. METHODS: A scoping review was conducted by performing a systematic search of Scopus, PubMed, CINAHL, and PsycINFO between 2013 and 2024. Studies focusing on emergency access among adult patients older than 18 years cared for by a palliative home care service were included. RESULTS: Eight retrospective studies across Italy, China, Canada, Australia, and Ireland were included. The studies revealed significant variability in ED visit rates, ranging from 8.6% to 69.15%, with cancer as the predominant diagnosis among patients. Dyspnea, pain, and fever were commonly cited reasons for ED visits, indicating potential gaps in symptom management at home. DISCUSSION: The review highlights the importance of early enrollment in palliative home care services, multidisciplinary care, and better caregiver education to reduce unnecessary ED visits. The findings underscore the need for further research on predictive factors, avoidable versus unavoidable ED visits, and strategies for optimizing home-based palliative care to enhance patient outcomes and quality of life.

LONGHINI, Jessica

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